Ghrelin gastric tissue expression and wall thickness in patients submitted to laparoscopic sleeve gastrectomy as the primary weight loss procedure

Background Ghrelin (Ghr) plays a role in the regulation of food intake. Laparoscopic sleeve gastrectomy is used for treatment of morbid obesity following which the expression of ghrelin can be modulated. The aim of the present study was to analyse the expression of ghrelin in three areas of resected stomach specimens from morbid obese patients and correlate these data with plasmatic ghrelin levels before and after surgery and measure the wall thickness of the fundus, body and prepyloric area of the resected stomach and its relation to the stapler thickness (green or gold cartridge) used. Patients and methods Thirty morbidly obese patients were subjected to laparoscopic sleeve gastrectomy, and tissue samples were obtained from the fundus, body and prepyloric area of the resected stomach for mRNA and protein expression analysis. Blood samples were collected before and 1 month after surgery to evaluate the plasmatic ghrelin levels and for histologic examination to detect its wall thickness. Results Ghrelin protein expression was higher in the fundus than in the other areas. Total ghrelin plasma levels decreased significantly from 70.2 +/- 80.4 pg/ml before surgery to 12.2 +/- 29.3 pg/ml after surgery. The wall thickness of the prepyloric area was higher than that of the body and fundus, which is the reason for the use of a green cartridge at the prepyloric area (higher thickness) and a gold cartridge at the body and fundus (less thickness). Conclusion Ghrelin protein expression was higher in the fundus than in the body and prepyloric areas. The wall thickness of the prepyloric area is higher than that of the body and fundus.